Epidemiological Study of Coccidioidomycosis in Greater Tucson, Arizona

Persistent Link:
http://hdl.handle.net/10150/194922
Title:
Epidemiological Study of Coccidioidomycosis in Greater Tucson, Arizona
Author:
Tabor, Joseph Anthony
Issue Date:
2009
Publisher:
The University of Arizona.
Rights:
Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
Abstract:
The goal of this dissertation is to characterize the distribution and determinants of coccidioidomycosis in greater Tucson, Arizona, using landscape ecology and complex survey methods to control for environmental factors that affect <italic>Coccidioides</italic> exposure. Notifiable coccidioidomycosis cases reported to the health department in Arizona have dramatically increased since 1997 and indicate a potential epidemic of unknown causes. Epidemic determination is confounded by concurrent changes in notifiable disease reporting-compliance, misdiagnosis, and changing demographics of susceptible populations. A stratified, two-stage, address-based telephone survey of greater Tucson, Arizona, was conducted in 2002 and 2003. Subjects were recruited from direct marketing data by census block groups and landscape strata as determined using a geographic information system (GIS). Subjects were interviewed about potential risk factors. Address-level state health department notifiable-disease surveillance data were compared with self-reported survey data to estimate the true disease frequency.Comparing state surveillance data with the survey data, no coccidioidomycosis epidemic was detectable from 1992 to 2006 after adjusting surveillance data for reporting compliance. State health department surveillance reported only 20% of the probable reportable cases in 2001.Utilizing survey data and geographic coding, it was observed that spatial and temporal disease frequency was highly variable at the census block-group scale and indicates that localized soil disturbance events are a major group-level risk factor. Poststratification by 2000 census demographic data adjusted for selection bias into the survey and response rate. Being Hispanic showed similar odds ratio of self-reporting coccidioidomycosis diagnosis as of being non-Hispanic White race-ethnicity when controlled by other risk factors. Cigarette smoking in the home and having a home located in the low Hispanic foothills and low Hispanic riparian strata were associated with elevated risk of odds ratios for coccidioidomycosis. Sample stratification by landscape and demographics controlled for differential classification of susceptibility and exposures between strata.Clustered, address-based telephone surveys provide a feasible and valid method to recruit populations from address-based lists by using a GIS to design a survey and population survey statistical methods for the analysis. Notifiable coccidioidomycosis case surveillance can be improved by including reporting compliance in the analysis. Pathogen exposures and host susceptibility are important predictable group-level determinants of coccidioidomycosis that were controlled by stratified sampling using a landscape ecology approach.
Type:
text; Electronic Dissertation
Keywords:
capture-recapture; complex survey; multiple imputation; population control adjustment; valley fever
Degree Name:
Ph.D.
Degree Level:
doctoral
Degree Program:
Epidemiology; Graduate College
Degree Grantor:
University of Arizona
Committee Chair:
O'Rourke, Mary Kay

Full metadata record

DC FieldValue Language
dc.language.isoENen_US
dc.titleEpidemiological Study of Coccidioidomycosis in Greater Tucson, Arizonaen_US
dc.creatorTabor, Joseph Anthonyen_US
dc.contributor.authorTabor, Joseph Anthonyen_US
dc.date.issued2009en_US
dc.publisherThe University of Arizona.en_US
dc.rightsCopyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.en_US
dc.description.abstractThe goal of this dissertation is to characterize the distribution and determinants of coccidioidomycosis in greater Tucson, Arizona, using landscape ecology and complex survey methods to control for environmental factors that affect <italic>Coccidioides</italic> exposure. Notifiable coccidioidomycosis cases reported to the health department in Arizona have dramatically increased since 1997 and indicate a potential epidemic of unknown causes. Epidemic determination is confounded by concurrent changes in notifiable disease reporting-compliance, misdiagnosis, and changing demographics of susceptible populations. A stratified, two-stage, address-based telephone survey of greater Tucson, Arizona, was conducted in 2002 and 2003. Subjects were recruited from direct marketing data by census block groups and landscape strata as determined using a geographic information system (GIS). Subjects were interviewed about potential risk factors. Address-level state health department notifiable-disease surveillance data were compared with self-reported survey data to estimate the true disease frequency.Comparing state surveillance data with the survey data, no coccidioidomycosis epidemic was detectable from 1992 to 2006 after adjusting surveillance data for reporting compliance. State health department surveillance reported only 20% of the probable reportable cases in 2001.Utilizing survey data and geographic coding, it was observed that spatial and temporal disease frequency was highly variable at the census block-group scale and indicates that localized soil disturbance events are a major group-level risk factor. Poststratification by 2000 census demographic data adjusted for selection bias into the survey and response rate. Being Hispanic showed similar odds ratio of self-reporting coccidioidomycosis diagnosis as of being non-Hispanic White race-ethnicity when controlled by other risk factors. Cigarette smoking in the home and having a home located in the low Hispanic foothills and low Hispanic riparian strata were associated with elevated risk of odds ratios for coccidioidomycosis. Sample stratification by landscape and demographics controlled for differential classification of susceptibility and exposures between strata.Clustered, address-based telephone surveys provide a feasible and valid method to recruit populations from address-based lists by using a GIS to design a survey and population survey statistical methods for the analysis. Notifiable coccidioidomycosis case surveillance can be improved by including reporting compliance in the analysis. Pathogen exposures and host susceptibility are important predictable group-level determinants of coccidioidomycosis that were controlled by stratified sampling using a landscape ecology approach.en_US
dc.typetexten_US
dc.typeElectronic Dissertationen_US
dc.subjectcapture-recaptureen_US
dc.subjectcomplex surveyen_US
dc.subjectmultiple imputationen_US
dc.subjectpopulation control adjustmenten_US
dc.subjectvalley feveren_US
thesis.degree.namePh.D.en_US
thesis.degree.leveldoctoralen_US
thesis.degree.disciplineEpidemiologyen_US
thesis.degree.disciplineGraduate Collegeen_US
thesis.degree.grantorUniversity of Arizonaen_US
dc.contributor.chairO'Rourke, Mary Kayen_US
dc.contributor.committeememberO'Rourke, Mary Ken_US
dc.contributor.committeememberHarris, Robinen_US
dc.contributor.committeememberSterling, Charlesen_US
dc.identifier.proquest10323en_US
dc.identifier.oclc659751909en_US
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